Outline

Objective

Long-term disease free survival occurs in less than 10% of patients suffering from malignant glioma. The only local therapy proved to be beneficial in case of recurrency in a randomised trial is surgical resection with the placement of iomustine-releasing wafers. Palliation with high quality of life is achieved by multiple reirradiation techniques. In this context we report on intracavitary radiation with GliaSite RTS.

Methods

In the past 12 months, 5 patients (age: 15 to 66 years) were treated with GliaSite RTS for recurrent malignant glioma. All patients had received standard therapy including one or more tumour resections and radiation therapy. Three of them had been previously treated with chemotherapy. MRI showed recurrent tumours in all patients. Following tumour resection, confirming malignant glioma histologically, a balloon was placed into the cavity, which was postoperatively injected with a solution containing contrast enhancing media. The correct position was verified by MRI. The solution was then replaced by sodium 3-(I125)iodo-4-hydroxybenzenesulfonate (I125-HBS) (Iotrex) delivering a total dose of 50 Gy (n=3) or 60Gy (n=2) at a 10 mm distance to the balloon surface in 4 to 7 days. The system was removed in a second operation.

Results

In all cases GliaSite RTS was placed and loaded without complications. All patients tolerated the procedure well. One patient developed a transient psychosyndrome. No additional neurologic deficit occurred. In one patient a local CSF fistula required an operative closure. His course was further complicated by persistent meningitis and a massive brain oedema. In his case tumour progression was likely, and radiation necrosis could not be excluded. In the other 4 patients no tumour progression could be observed on 3 months`follow-up MRI.

Conclusions

Intracavitary brachytherapy with GliaSite RTS is a generally well-tolerated reirradiation technique. Short-term local tumour control is achieved in most cases. Long-term follow-up is necessary to determine the effects on the qualitiy of life and the frequency of recurrencies.